Provider Demographics
NPI:1083757660
Name:LOUTZENHISER, ERIN RENEE (MD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:RENEE
Last Name:LOUTZENHISER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:RENEE
Other - Last Name:RIVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1423 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65802-1917
Mailing Address - Country:US
Mailing Address - Phone:417-269-3465
Mailing Address - Fax:417-269-8189
Practice Address - Street 1:1000 E PRIMROSE ST
Practice Address - Street 2:STE 170
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-5154
Practice Address - Country:US
Practice Address - Phone:417-269-9812
Practice Address - Fax:417-269-3796
Is Sole Proprietor?:No
Enumeration Date:2007-02-14
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006018984207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine